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NPI Code Detail

MEDICARE: STACY ELIZABETH MASON

MEDICARE: STACY ELIZABETH MASON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor7033785-6006UT

General Provider Information

NPI Number : 1831335413
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY ELIZABETH MASON
Provider Business Mailing Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341
Country : US
Telephone Number : 435-792-6491
Fax Number :
Provider Business Practice Location Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2009
Last Update Date : 01/02/2009

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Directions to “ STACY ELIZABETH MASON ” Practice Location

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